- Title
- Effects of antidepressants on gastric function in patients with functional dyspepsia
- Creator
- Lacy, B. E.; Saito, Y. A.; Camilleri, M.; Bouras, E.; DiBaise, J. K.; Herrick, L. M.; Szarka, L. A.; Tilkes, K.; Zinsmeister, A. R.; Talley, N. J.
- Relation
- American Journal of Gastroenterology Vol. 113, Issue 2, p. 216-224
- Publisher Link
- http://dx.doi.org/10.1038/ajg.2017.458
- Publisher
- Wolters Kluwer
- Resource Type
- journal article
- Date
- 2018
- Description
- Background: Functional dyspepsia (FD) is a highly prevalent functional bowel disorder. The effects of antidepressant therapy (ADTx) on gastric sensorimotor function in FD patients are poorly understood. Aims: Determine whether FD and subtypes with abnormalities in gastric function respond differently to ADTx compared to those with normal physiology. Methods: This multicenter, prospective trial randomized FD patients to 12 weeks of amitriptyline (AMI; 50 mg), escitalopram (ESC; 10 mg), or matching placebo. Demographics, symptoms, psychological distress, gastric emptying, and satiation were measured. Gastric accommodation (GA) using single-photon emission computed tomography imaging was performed in a subset of patients. An intent to treat analysis included all randomized subjects. The effect of treatment on gastric emptying was assessed using ANCOVA. A post hoc appraisal of the data was performed categorizing patients according to the Rome III subgrouping (PDS and EPS). Results: In total, 292 subjects were randomized; mean age=44 yrs. 21% had delayed gastric emptying. Neither antidepressant altered gastric emptying, even in those with baseline delayed gastric emptying. GA increased with ADTx (P=0.02). Neither antidepressant affected the maximal-tolerated volume (MTV) of the nutrient drink test although aggregate symptom scores improved compared to placebo (P=0.04). Patients with the combined EPS-PDS subtype (48%) had a lower MTV on the nutrient drink test compared to the EPS group at baseline (P=0.02). Postprandial bloating improved with both AMI (P=0.03) and ESC (P=0.02). Conclusions: Amitriptyline (50 mg) improves FD symptoms but does not delay gastric emptying, even in patients with baseline delayed gastric emptying. GA improved with low-dose ADTx; the precise mechanism of action is unknown warranting further study.
- Subject
- antidepressants; gastric function; functional dyspepsia; functional bowel disorder
- Identifier
- http://hdl.handle.net/1959.13/1410006
- Identifier
- uon:36109
- Identifier
- ISSN:0002-9270
- Language
- eng
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